Upper respiratory disorders

Common cold

Most “colds” are upper respiratory tract infections caused by one of a host (at least 200) of viruses. It is not true that exposure to a cold climate (“catching a chill”) causes a cold. Symptoms include runny nose, cough, sore throat, headache, muscle aches, fever, fatigue, weakness, and occasional nausea with vomiting and/or diarrhea. Unfortunately, there is no cure for the common cold. The best medicine is rest (although mild exercise might make you feel better), increased fluid intake to prevent dehydration and loosen secretions, and acetaminophen or aspirin for fever. To avoid Reye syndrome (postviral encephalopathy and liver failure), don’t use aspirin to control fever in a child under age 17. Use acetaminophen in preference to ibuprofen.

Keep the victim warm (particularly the feet) and dry. For persons ages 6 years and older, treat nasal congestion with an oral decongestant and nasal spray (use the latter for 3 days maximum). Be aware that an oral decongestant can make a child hyperactive. For an infant, use saline nose drops (¼ teaspoon [1.3 mL] of table salt in 1 cup [237 mL] of water) in a dose of two to three drops in each nostril a few times a day; the child will sneeze, or the drops can drain via gravity or be sucked out with a “baby bulb” syringe. When blowing your nose, be gentle, in order to avoid pushing mucus from the nose up into the sinuses.

A person who breathes steam (which has not been proved to improve a common cold) must be careful to avoid burns. There is no scientific evidence to support the use of chest rubs or megavitamins (specifically, vitamin C) in the prevention or diminution of viral illnesses. Probably the most important factor in rehabilitation is adequate rest.

Don’t attempt to “sweat out” a cold with vigorous exercise. Such behavior causes worsened fever, dehydration, and debilitation. A person with a cold should see a doctor if they are ill for more than 3 weeks, their temperature elevation becomes extreme (see page 188), they develop a cough productive of yellow-green or darkened phlegm (see pages 55 and 227), or they develop chest pain associated with breathing, shaking chills, a severe earache, or a headache with a stiff neck (see page 196). Since colds are spread by contact, take particular care to wash and gel your hands after contact with an infected person.

The most common complication of a cold in a child is a middle ear infection. If a young child with a runny nose and cough begins to pull at their ear(s) or if a fever returns near the end of the course of a cold, consider treating the child for otitis media (see page 198). Pneumonia can also be a complication (see page 55). It should be suspected in any young child who appears short of breath (respiratory rate above 30 per minute in a child, or 40 per minute in an infant).

A cold can be differentiated from seasonal allergies based on the following: cold—fever, chills, yellowish or green nasal discharge, sore throat, diarrhea, muscle aches; allergies—clear nasal discharge, repetitive sneezing, watery and itchy eyes.

Someone who has a chronic (lasts longer than 3 weeks) cough not clearly associated with a cold or other viral infection of the respiratory tract, who is coughing up blood, or who has another known problem such as pneumonia or lung cancer should seek the attention of a physician. The most common causes of a chronic cough are cigarette smoking, postnasal drip (often stimulated by seasonal allergies), unsuspected asthma, lung disease (such as chronic obstructive pulmonary disease [COPD]—see page 54), chronic sinus infection, or acid reflux from the stomach into the esophagus. In addition, persons who take angiotensin-converting enzyme (ACE) inhibitors to treat high blood pressure might develop a cough; this usually disappears a few days after the medicine is discontinued.

A U.S. FOOD AND DRUG ADMINISTRATION ADVISORY PANEL IN 2007 RECOMMENDED THAT THERE IS NO EVIDENCE THAT OVER-THE-COUNTER COLD AND COUGH MEDICINES WORK IN CHILDREN AND THAT THE PRODUCTS SHOULD NOT BE GIVEN TO CHILDREN YOUNGER THAN 6 YEARS OF AGE.